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- 12. DEDUCTIBLE Paid Annually Per Person or Per Family * All Covered Expenses apply towards the deductible first INSURANCE CARRIER Pays 100% for Covered Expenses COINSURANCE Paid Annually Per Person or Per Family 50/50 60/40 70/30 80/20 90/10 100% (% of next $5,000 - $20,000 after deductible) *Most are an additional $2,000
- 22. We appreciate you letting others know how we helped with your concerns today! *Make sure to ask your agent about our referral program
Editor's Notes
- (First, have a 5-15 minute warm-up conversation. Get to know about your prospect)
- Before we get started I wanted to just look at a few questions you may have? Who am I? Why Custom Select Insurance Services? How are doctor visits and prescriptions be covered? Are annual exams covered? How much will it cost? When will my coverage begin? How long will this take today? Are there any questions that you may have that are not listed? (Write down anything they mention) Let me tell you a little bit about me. (Provide very brief description of your qualifications) I will address the other questions listed as we look at the various plans over the next 20-30 minutes. If the additional question(s) they mentioned are covered in our presentation, say: The other question(s) you mentioned will also be covered as we go through the various plans as well. If the additional question(s) they mentioned are notcovered in our presentation, say: But let me first answer the other question(s) you mentioned.
- John and Mary first let me tell you about Custom Select, and how we can help you with your concerns today . Our job is to help you shop through all the available carriers in (Their State) and figure out with our preferred carriers which ones would be the best for what you want. Then we will narrow it down to just two copay plans and two HSA plans, set them side by side and figure who has the best price. Does that make sense?
- What we cover today will be to initially get familiar with what you are looking for in a health policy and obtain a brief health history. We will then take just 5-10 minutes to help make insurance simple and easy for you. That would be nice, would it? Of course it would be. So we will address things like what options you have, what your premiums actually cover and the difference between a copay plan and a health savings account, also known previously as a flexible spending account or flex plan. We will then review the quotes, address questions and decide which plan is best for you today. Sound good? Before we get started I need to get a little bit of information from you and find out what you are really looking for in an insurance policy. That will help me direct you towards the companies that can best address those issues. I really want to stress that if you truly do want to shop what’s available in (Their State) we are going to help you do that today. So if we find a plan that works for you and it makes sense, we will help you get an application into underwriting today. That’s fair enough, isn’t it? <Complete/Review Family Data Sheet>
- John & Mary, many people do not realize that insurance costs the same no matter where you buy it as it is regulated by the state. The advantage of working with an agent is that you have someone on your side making sure you get what you are looking for at the best price available. The advantage of working with me versus other agents is I actually work with the largest selection of carriers available. What I mean by this is most agents only work with just two or three companies and then try to find reasons why you should buy one of those companies. It is more important to me that you actually get the plan you need regardless of which company it is with. I am sure you are tired of having to shop for insurance, right? Well, you can feel comfortable that today we will find the best plan for you and you won’t have to keep shopping around. Would that be okay with you?
- As I mentioned, we work with the largest selection of insurance companies. This is the list of companies we currently represent. Did you realize there were so many of them? It is nice to know that we are checking with all of these companies to find you the right plan and not just two or three, isn’t it? Of course it is. Who are a couple of people that you know that are struggling trying to find insurance right now? Are they open minded people? Do you think they would mind if I sent them a letter or email? Great. What are their names and address or email address? John & Mary, the information I will go through should answer most of your questions, Option 1 . But I would like you to use this notepad to write down any questions that come up so we can address those at the end. Would that be okay? Great Option 2 . But if you have a question, stop me, because I can only help if this makes sense. Fair enough? Great.
- <Replacing Coverage> Since you… Have insurance, do not cancel it until we have your new policy in effect. That also means we don’t need to look at temporary insurance now. Are going to replace your current, do not cancel your current insurance until we know that the new policy has been issued. We will set it up so your new plan starts the day you old one ends. <Temporary Insurance> As you are just in between jobs right now and may get insurance with your new employer, it will probably make the most sense to just purchase a short term insurance policy today. or As you do not have insurance right now you may want to consider starting a temporary insurance until your main policy goes into effect. <Pre-existing Conditions> Fortunately, you do not have any pre-existing conditions to worry about. or Pre-existing conditions in your situation are (List all pre-existing conditions) . These conditions may be… Rated, which may increase rates slightly I will adjust your rates to account for possible underwriting changes from their standard rates. So what we show you today should be pretty close to what you can expect from the insurance companies. They could also be ridered or excluded, which means the carriers will cover you for everything, except some or all of those conditions we just discussed. <Underwriting Process> Underwriting will generally take a day up to 5 weeks, so you could expect to have your policy in place by (Date their current insurance policy expires or a minimum of 30 days from application date) . Does that all make sense? Good
- The two options you may have are group or individual coverage. Group plans are either a business group of one which is for the self-employed, a smaller group of 2-50 employees or the larger groups like the state employees. An individual plan is any individual or family, like you (and your family) . Also, under the group plans you do not have any health restrictions, so if you have any pre-existing health conditions you’ll be able to get those covered without any concern. ( If Group Option required: Because of your pre-existing conditions, I also brought these options since you can qualify.) Individual plans are based on your individual (families’) risk and that determines your rates, not like group plans that base your rates on the overall risk of the entire group. This simply means group rates are typically much more expensive than an individual plan. And that’s part of the reason you’re shopping today, because of cost, right? Another concern with group plans is if you leave your job, retire or the company changes what they offer for insurance you may have an option with COBRA, which means you can keep the plan from work, but you must pay the entire cost which is usually too expensive for any of us to pay. Plus, that only lasts for eighteen months. After eighteen months guess what? That’s right, you’re back in the individual market, but that is only if you can still health-qualify. When you are on an individual policy, you own that insurance policy and no one can take it away from you. And once you have been accepted, you cannot be canceled or have your rates increased based on your claims. And most plans will also cover you on and off of the job. Does that make sense? Great.
- As you probably know the biggest differences between HMO’s & PPO’s is that HMO’s may have a limited coverage area, while PPO’s allow you to be in or out of a network of providers that you choose and they typically cover you nationally. With HMOs you may also have limitations in seeing specialists. That means you may have limited options for the best available care. With a PPO you choose any specialist without referrals within your network. So obviously this is going to be the better choice for the best care, wouldn’t you agree?
- Today John & Mary, you have 3 basic types of plans to choose from. All will work virtually the same after meeting your chosen deductible and coinsurance. However, the premiums for each can vary quite a bit, so that’s why we feel it is important for you to understand these options. The plans you are probably most use to are Copay Plans. They offer you set copays for doctor visits and prescriptions, but Copay Plans are the most expensive option today. With these plans you will also have individual deductibles and coinsurance, meaning per person, which I will explain in just a minute. Deductible 1 st and Health Savings Account plans work very similar to auto insurance. Think of it this way, if you called your auto insurance company today, John, how much do you think they would raise your rates if you ask them to give you a “copay” to change your oil every 3,000 miles and tune up your car once a year? Right, they would probably laugh, but then they would double your rates. Well, that is how copay plans work. Today if you want an insurance company to assume your “usage risk”, like doctor visits and prescriptions and give you set copays, you will have to pay higher premiums every month. That is why Deductible 1 st Plans are your least expensive option. You get negotiated rates for doctor visits, which I will explain in a minute and discounts on prescriptions and you still have individual deductibles and coinsurance. Fortunately we now also have the choice of having Health Savings Accounts. They are the solution to the rising cost of healthcare today. They are less expensive than traditional Copay Plans and work similar to a deductible 1 st plan. But a HSA allows you to tax-defer money in an IRA that can be used for your medical expenses. That money may also be used for non-covered medical expenses, like Lasik surgery. And you get the benefit of having family deductibles and coinsurance. Depending on the carrier you may be offered a copay to have an annual physical exam as well. Based on what you have learned so far, which of these types of plans sounds the best to you? Great.
- When you are dealing with a major medical plan here in the United States they all tend to work pretty much the same. But with the high cost of insurance understanding where your money actually goes is the most important, especially if you don’t go to the doctor a lot. Let me explain what I mean. For example, when you see a doctor, get a prescription, go into the hospital or have surgery you create a “bill”. That “bill” is sent to the network you are attached to and they re-price it. The doctors and hospitals have agreed to lowered rates if a network is used, that’s like Sloans Lake, PHCS, UHC or several others. That’s why I asked what doctors you want to keep, so we look at plans that will allow you to do that. Once the bill has been re-priced it is then forwarded to the insurance company. The re-priced rates will either be covered under your copay or go against your deductible and coinsurance; meaning you will pay either a copay or the re-priced rate, also known as the negotiated rate for those services. Does that make sense? Great.
- John & Mary the next part relates to your premiums. They entitle you to a deductible and coinsurance that you must meet before the insurance company will pay. Deductibles are typically annual. They are either per person up to 3 per year per family or they are family deductibles that everyone meets together. After meeting the deductible you chose then you have coinsurance. Coinsurance is also per person or per family. Have you ever heard the term 80/20 or maximum-out-of-pocket? What that relates to is coinsurance and if you are on an 80/20 plan you will share 20% of the next $5,000 to $20,000 of medical expenses on top of your deductible, depending on the carrier. Generally you can expect to have an average of an additional $2,000 of coinsurance per person with an 80/20 plan. After all this then the insurance company will pay 100% for covered expenses for the rest of that year.
- John & Mary as consumers what we have to decide is our “usage risk”, meaning how many doctor visits and prescriptions do we plan on needing every year. This is an unknown risk factor to the insurance companies so if you are willing to pay a higher premium the insurance company will assume some risk for your daily usage, meaning they will offer you copays. Copays will not count towards the deductible and they are continuous beyond the deductible. Now, you do have the option of lowering your premiums by paying the negotiated rates for your doctor visits and using discount cards for your prescriptions. Negotiated rates for doctor visits are usually between $25-85 a visit and prescriptions are usually discounted 23%. The advantage is what you pay for doctor visits and prescriptions will also count towards your deductible. And if the deductible is met there are no further costs to you for any covered expenses including the doctor visits and prescriptions for the rest of the year. Pretty nice, huh? Let’s face it, neither side do you want to meet a deductible, because that means something bad has happened to someone. But wouldn’t it be nice to know John & Mary that if you do have to meet your deductible you paid less every month to have the insurance and now there are no further out-of-pocket medical expenses to you for the rest of the year, including doctor visits and prescriptions. Sounds pretty good doesn’t it?
- So let’s just review some of the advantages of the HSA plans. First, you have just one deductible for the family and no additional coinsurance. Second, the premiums are lower. It is important however that we compare premiums based on overall responsibility. Let me explain. With a copay plan that has a $500 deductible and 80/20 coinsurance your total annual responsibility is $5,000. This is because you could have to meet the $500 up to two times in a year which equals $1,000. Then you have another $2,000 per person with the 80/20 coinsurance which is an additional $4,000. All together that equals $5,000 of annual responsibility to you and then the insurance covers 100%, except for doctor visits and prescriptions. With the HSA plan you could also have an annual responsibility of $5,000. But that is a single deductible that is shared by everyone. Since the coinsurance is 100% there is no additional responsibility, thus the entire annual responsibility is just the $5,000. When we review the plans I will show you the apples-to-apples comparison so you can see the difference in cost. Now with the premiums you will save you can set that money aside tax deferred and use it to pay for your medical expenses like doctor visits and prescriptions or even your deductible. But that is not all. You can also use that money to pay for over the counter medications, dental and vision expenses or even alternative or elective procedures. This money will earn interest for you and you will never lose it like flexible spending account plans employers may offer. Pretty nice, huh?
- Okay, let’s talk about the specific health plans that will work the best for your concerns. Believe it or not we will go through how all the plans in (Your State) work in the next few minutes. The reason some agents will go into so much detail on plans is that they usually only have a couple plans to work with, so they need to fit you into their box. Custom Select actually finds the box that fits you best at the best price available. That’s nice to know, isn’t it? With that in mind there are really only 5 things that change amongst major medical carriers. First is how doctor visits and annual exams, like having a physical are covered. Second, what are the prescription options and is there a separate deductible for prescriptions you may have to meet before using any copays. Third, we will also point out important service limitations that you need to be aware of like an annual maximum of coverage that the company will pay. Also, you need to know worst case scenario, what is the amount you’re going to have to pay out of pocket in any given year. And last, what is the most the insurance company is going to pay per person’s lifetime. Did you realize that insurance was really that simple? I know, it’s surprising, but that’s what’s so nice about Custom Select. We believe that if you cannot put your policy in the drawer after you get it and not worry about it then you probably shouldn’t have that plan. Make sense?
- Now John & Mary let me ask you, what would be your biggest concern should you have to use your health insurance? Would it be having to meet your deductible and coinsurance? Of course it would. That’s why we have supplemental options. They keep you secure in the event of an illness or accident so you can maintain your current lifestyle and help offset your out-of-pocket expenses when something happens, like your deductible or even your lost income. And they work with any of the plans you choose today. These plans also help you reduce your health insurance premium, because you can take a higher deductible since they will help you pay for it. Does that make sense? Great. Over eighty percent of the reason people use their health insurance in the United States today according to Mutual of Omaha, is for accidents or injuries. So it only makes sense to at least have an accidental supplement with any plan you carry. This money is paid directly to you to offset any out of pocket expenses, like your deductible. They even cover services that may be limited on a health plan like a chiropractor. Does this make sense?
- The way this works is per incident, per person, they will pay you up to $2,500. This money is paid directly to you to offset any out of pocket expenses, like your deductible. For example, if you broke your arm and went to the emergency room your insurance policy would cover your treatments, but it would count against your deductible and coinsurance so you would have to come up with the money. This plan would pay to you up to $10,000 of what you had to pay and they only have a $250deductible. So this reduces your out-of-pocket expense to just the $250and the insurance still credits your deductible for the full amount of the bill. Does that make sense? In addition to the $10,000 lump sum benefit, they provide additional money should anyone have to use Flight-for-Life and an accidental death benefit for everyone. See why this is so popular? That addresses accident related concerns, but what about if you were sick or disabled? Say you became totally disabled due to an illness or an accident, what will be the first thing you miss? Your paycheck, that’s right. You can also add a critical illness benefit that pays you if someone is diagnosed with cancer, heart attack, kidney failure, stroke and many other illnesses. Again, this helps you to not only cover your deductible and coinsurance, but it helps with your daily living expenses. It only makes sense to at least have a plan like this with your insurance, doesn’t it? Of course it does.
- Well let’s take a look at what the health insurance premiums are and see what will work best for you. Then we can complete the application and get it to the insurance company since it takes typically a day up to 5 weeks to get through underwriting. <Review the plan options> As you can see, helping you get the right plan is our main concern. Who are 3, but no more than 5 people you know that I should be speaking with right away? Let me explain what happens during underwriting and then we will be done. First, do not cancel any insurance you already have until underwriting has completed, because we do not want you left without any insurance. Here are the rates for the Short Term insurance I mentioned earlier. Did you want that to go into effect tomorrow while we wait for the other plan to get issued? (So you’re okay going uninsured for another thirty days or so?) Okay. During underwriting you will receive a phone call from our office to verify the information on your application. You may also receive a phone call from the insurance company; be aware that the insurance companies job is to try to find a way to decline you, so answer their questions truthfully, but do not give your opinions of your health conditions; let your medical records provide details. They may ask for a physical exam, but that is very unlikely. They may need to get medical records from your doctors and if there is a delay with getting them we may ask you to help us get that taken care of. Okay?
- By the way we can also help you with your life insurance concerns. Would you like me to get you a quote? How much were you thinking about getting to protect the family? Great, I will follow up with you on this in a day or two.
- The issue date is the date when underwriting has been completed. The effective date is the date coverage is in force. They will cover you retro-actively to the date you requested coverage to begin if underwriting went beyond it. The policy should come out just like we have discussed, but if there are any changes I will get back in touch with you and go through your options at that time. The nice thing is that we can make changes with plans if you want while other agents are somewhat limited with options. That’s just one of the many things Custom Select can do for you. A rating would occur only for any additional health risks you may have, as I mentioned before.
- An exclusion or waiver will exclude coverage only for a particular condition for 6 -12 months or indefinitely. If you were declined I will be back in touch with you to discuss the available options. And remember, as changes occur CSIS will be there to help. So if one company isn’t working for you, let me know so we can get you moved to another carrier. Okay? I will email you the brochures outlining the coverage that we have discussed and a reminder of what happens during the next few weeks. Your receipt is right here and I signed and dated it with my State license number.
- Now, John & Mary if this is not something you are comfortable with or this does not make sense, then I don’t want you to start anything today. But if you feel that I have answered all your questions and that we have truly found the best plan for your concerns and plan on keeping it for at least 6 months, then we will get everything into underwriting today. (If they cannot commit for 6 months, offer a short term option) Fair enough? Do you have any questions while I am still here? Great. It has been a pleasure meeting with you and don’t forget to let others know how we helped you today. Have a good day/evening.